Permissive hypercapnia

The pursuit of normal arterial blood gases in patients with severe acute respiratory failure is not always appropriate. Improvements in oxygenation and CO 2 clearance can be offset by exacerbating lung injury. Acceptance of non-physiological targets may reduce this risk. Arterial CO 2 tension (PaCO2) is gradually allowed to rise by reducing tidal volumes to 4 to 7 ml/kg and avoiding high peak airway inspiratory pressures. Permissive hypercapnia appears to be well tolerated, and the resulting respiratory acidosis is usually compensated for by renal retention of bicarbonate.

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